July 16, 2012 — Use of a selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI) by patients having face- and neck-lift procedures is not associated with an increased risk of bleeding, new research indicates.

"We found no evidence to support discontinuing SSRIs perioperatively," the authors, led by Sanaz Harirchian, MD, Department of Otolaryngology–Head and Neck Surgery, University of Medicine and Dentistry of New Jersey in Newark, and colleagues write.

The study is published in the July/August issue of Archives of Facial Plastic Surgery.

Hematoma formation is the most common complication of rhytidectomy, with an incidence of 0.2% to 8.1%. Recently, SSRIs have come under scrutiny because of possible bleeding risks.

The current theory "proposes an inhibition of serotonin uptake into platelets, leading to an impairment in the platelet hemostatic response. While there are observational studies and case reports of hemorrhagic risks associated with SSRIs, clinical trials and level I evidence are lacking," the authors write.

"To our knowledge, this is first study evaluating the effects of SSRIs on postoperative bleeding in the facial plastics literature," they add.

They reviewed the charts of 250 consecutive patients who underwent a modified deep-plane face-lift and 13 patients who underwent neck-lift from January 2010 to May 2011.

Among all 263 patients, 58 (22%) were using SSRIs or SNRIs at the time of surgery.

"One major bleeding complication occurred, requiring surgical intervention, resulting in a total hematoma rate of 0.38%," the authors say. The patient was a 62-year-old woman taking a low-dose SSRI who underwent revision rhytidectomy. She had no history of coagulopathy and was not taking any known nonsteroidal anti-inflammatory drugs or aspirin. The hematoma manifested within the first 12 postoperative hours, requiring surgical evacuation.

The researchers say their study is limited by its "low power," and they cannot establish a causal relationship between SSRI use and postoperative bleeding.

"While this study cannot definitely rule out a small increased risk of postoperative bleeding with the usage of SSRIs, we can conclude that the rate of hematoma among SSRI users is small and comparable with published rates of major hematoma. In addition, the rates of total hematoma between non–SSRI users and SSRI users are comparable," the investigators write.

The authors also note that the 22% rate of SSRI use is "significant and reflects the prevalence of depression and anxiety in this group of patients. Given the risk of cessation of SSRIs, the low hematoma rate among users and the lack of level I evidence supporting bleeding, our study does not find good reason to stop SSRIs in the perioperative period."